Provider Demographics
NPI:1275653347
Name:SADDLE MOUNTAIN VOLUNTEER AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:SADDLE MOUNTAIN VOLUNTEER AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LEGAL REP
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:541-882-6984
Mailing Address - Street 1:2261 SOUTH SIXTH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-882-6984
Mailing Address - Fax:541-884-7585
Practice Address - Street 1:23536 SPRAGUE RIVER ROAD
Practice Address - Street 2:
Practice Address - City:SPRAGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97639
Practice Address - Country:US
Practice Address - Phone:541-882-6984
Practice Address - Fax:541-884-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBCN01011341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233836Medicaid
OR233836Medicaid